REPUBLIC OF THE PHILIPPINES)

PROVINCE OF SURIGAO DEL SUR)

CITY OF TANDAG) SS

AFFIDAVIT

I, BRYLLE SHAN JADE AMONGAN LIM, Filipino, of legal age, single and a
residing at Purok Neptune, Telaje, Tandag City, Surigao del Sur, under oath, state
THAT:

1. On November 2, 2023 at about 2:15 P.M, while driving a black/orange KIA

BONGO Double Cab Drop side with plate number KAK 6839, engine number JT-
386560, chassis number KN3HAP53A2K846838, registered under EMYLINE D.
DONASCO;

2. While traversing going south heading towards boulevard reaching in-front of

Department Trade and Industry (DTI) Office, situated in Purok Napo, Brgy. Bag-ong
Lungsod, Tandag City, Surigao del Sur, and then I slowly step the clutch preparing to
slow down and when I step the break to stop the bongo it loses its pressure and
continue rolling resulted to the mechanical error of the break, thinking the situation I
decided to accidentally bumped into a concrete post of Street light to avoid further
damages;

3. Unfortunately, Mark Anthony Canda sustained a minor injury after he was

caught of the glass of the fallen street light that fell towards him, later he was quickly
taken to Adela Serra Ty Memorial Medical Center for proper treatment;

4. Due to this accident the vehicle incurred into a minor damage, and damages
the government own Street light and injured a pedestrian walker:

5. I execute this affidavit to attest to the veracity of the foregoing statements of

the fact of the said accident due to mechanical error of the break of the vehicle that I
have driven and for whatever legal purpose this may serve best;

IN WITNESS WHEREOF, I hereby sign my name on this ____ day of

___________________ at Tandag City, Surigao del Sur.

BRYLE SHAN JADE AMONGAN LIM

Affiant
DL # L09-20-007463

SUBSCRIBED AND SWORN to before me on this _____ day of

_____________________ in the City of Tandag, Surigao del Sur, affiant is personally
known to the undersigned.

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Series of 2023.